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Strokes in Young People: Are the Numbers Really on the Rise?

Strokes in Young People: Are the Numbers Really on the Rise?

Age is a major factor for having a stroke, but older people aren't the only ones at risk.

Age is a major risk factor for having a stroke, and the risk of stroke doubles each decade after age 55. That doesn’t mean that adults in their 20s, 30s or 40s are too young to have a stroke or worry about high blood pressure and their heart health.

In fact, stroke rates among young adults appear to be on the rise. Globally, one in four adults older than 25 is at risk for stroke during his or her lifetime, according to a 25-year study published in December 2018 in the New England Journal of Medicine. Researchers looked at lifetime stroke risk starting at age 25 instead of 45. Stroke risks varied geographically and were lowest among adults in sub-Saharan Africa, but not because they have better heart health. Researchers believe this population is at a higher risk of death from other causes. The researchers stressed the importance of following a heart-healthy diet, getting regular physical activity, not smoking and curbing alcohol for stroke prevention.   

Between 2000 and 2010, hospitalizations for ischemic strokes (where blood flow to the brain is blocked by a clot) in people between the ages of 25 and 44 surged by 44 percent. At the same time, these admissions dropped nearly 30 percent among those who were decades older, or between 65- and 84-years old, according to a May 2016 study published in the Journal of the American Heart Association.

A separate June 2017 study published in JAMA Neurology also found that between 2003 and 2012, ischemic stroke hospitalizations jumped by 41.5 percent for men between 35- and 44-years old and increased 30 percent for women in this age group.

Is there an epidemic of ischemic stroke striking the young and middle-aged? Not exactly, says Noor Sachdev, MD, a neurologist with Good Samaritan Hospital in San Jose, California. “I don’t think anything has changed dramatically,” he says.

So why the big jump in strokes in younger people? Read on for Dr. Sachdev’s take and to learn what you can do to reduce your risk of having a stroke.

Better education and diagnosis
Sachdev believes better diagnosis contributed to the 44 percent increase, both on the patient side and the doctor side. “Younger people know more about the symptoms of stroke so they're coming into the hospital sooner and seeking treatment,” he says. “Our capabilities of diagnostic testing are also better." Younger people may not suddenly be having more strokes, but people are more educated about it, Sachdev says.

Groups like the American Heart Association and the American Stroke Association have worked hard to educate people about strokes, says Sachdev. Younger people may be more familiar with stroke symptoms and effects if their parents experienced a stroke. “Plus, they have the Internet. If they have a symptom they can look it up,” he says.

Warning signs of stroke can include:

  • Sudden numbness on one side of the body
  • Sudden confusion or trouble speaking
  • Sudden vision trouble
  • Sudden loss of balance or lack of coordination
  • Sudden and severe headache

If you think you or someone else is having a stroke, call 911 as soon as possible. First responders are now trained in identifying stroke patients and quickly taking them to stroke centers for treatment. CT scans are the first step in diagnosing stroke, and they can determine whether there is bleeding in the brain (hemorrhagic stroke) or if the stroke was the result of a clot.

The treatment approach depends on the results of the CT scan. Further testing such as MRIs, CT angiograms and perfusion studies, ultrasounds or cerebral angiograms also help to diagnose a stroke and its cause. “The technology is getting better. There is now software that can analyze cerebral blood flow, which can tell us if there’s a clot, what area of the brain is lacking blood flow and if there’s tissue that can be salvaged,” says Sachdev.

Causes of and recovery from strokes in young people
Better diagnostic tools and greater awareness could help explain the apparent increase in strokes among young people, but the causes are likely to be different in younger patients. While atherosclerosis is the most common cause of stroke overall, other artery problems like vasculitis, heart abnormalities, dissection (vessel tear) and blood clots are the most common reasons for strokes in younger patients.

Younger patients are also more likely to recover from a stroke more quickly and fully than older adults, Sachdey adds. “Younger patients, just by the nature of the brain itself, will heal faster no matter what you do,” he says. “You don’t get brain tissue back, but you have neuroplasticity, a constant rewiring and re-networking of the brain.” Younger people may also heal faster because they’re generally stronger, have fewer diseases and can better tolerate physical therapy, says Sachdev.

Preventing a stroke
Whether you’re 25 or 75, there are steps you can take to prevent a stroke. “We’ve gotten better in terms of medication, but lifestyle is key,” says Sachdev. “The number one risk factor is a previous stroke." Diabetes, high cholesterol, smoking, obesity and high blood pressure are other key risk factors for stroke.

Higher than normal blood pressure before the age of 40 is linked to a greater risk for heart disease and stroke, according to two November 2018 studies published in JAMA. One study involved nearly 5,000 American adults between 18- and 30-years old who were followed for an average of 18 years. During this time, researchers identified 228 cardiovascular events, including strokes. Using the latest hypertension guidelines, the scientists found stage 2 hypertension (consistently 140 mm Hg or higher systolic blood pressure or diastolic blood pressure of 90 mm Hg or higher) was linked to a 4.39 times greater risk for stroke than normal blood pressure (less than 120/80 mm Hg).

The second study analyzed the blood pressure rates of almost 2.5 million Korean adults between 20- and 39-years old. During a median follow-up period of 10 years, nearly 45,000 cardiovascular events were reported. Compared with those with normal blood pressure, men with stage 2 high blood pressure had a 99 percent higher risk of stroke. Meanwhile, high blood pressure more than doubled a woman's stroke risk.

You can start to lower your risk by making changes to your daily habits. “Just by meeting basic government recommendations on exercise,” says Sachdev, “you can increase your life expectancy by seven years.” Adults should still get at least 150 minutes of moderate-intensity physical activity or a minimum of 75 minutes of vigorous-intensity exercise each week, according to the latest guidelines from the U.S. Department of Health and Human Services (DHHS). Getting closer to 300 minutes a week of moderate exercise or 150 minutes of more strenuous activity, it’s even better. The more exercise you get, the greater the health benefits, but any amount of exercise or just moving more is beneficial, particularly among the most sedentary people, experts advise. Even a two-minute walk can help.

Research continues to suggest exercise can help lower high blood pressure levels and reduce the risk of stroke. In a December 2018 analysis published in the British Journal of Sports Medicine, researchers looked at data from 194 studies, which examined the impact of high blood pressure drugs, and 197 studies, which investigated the effects of exercise that included a combination of endurance activities, such as walking, running, cycling or swimming, and strength training. The review, which included nearly 40,000 people, highlights the potential benefit of physical activity. The researchers pointed out however, that people with high blood pressure should continue to take their medication as directed by their doctor. It’s also important to speak with your doctor before starting a new exercise regimen or adding more physical activity to your daily routine. 

There are a total of 10 risk factors, including inactivity, responsible for about 90 percent of all strokes worldwide—many of which can be reduced by making the right lifestyle changes, according to a July 2016 study published in The Lancet. The authors wrote that high blood pressure is the most important controllable risk factor.

Other risk factors in the study include:

  • Smoking
  • Excess belly fat
  • Poor diet
  • Alcohol consumption
  • Diabetes

The good news: all of these risk factors can be influenced to some degree by your choices and habits.

“Things happen in life that you can’t control, but you can control your health,” says Sachdev. “The culture of medicine is changing with the patient taking more responsibility for their health rather than just coming to the doctor to be fixed. There’s enough knowledge out there that shows how critical lifestyle modification is to overall health and well-being.”

This article was updated on February 6, 2019.

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